Provider Demographics
NPI:1306531223
Name:PERRY, CRYSTAL (LMT)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 LAUREL CANYON BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-5929
Mailing Address - Country:US
Mailing Address - Phone:818-237-6422
Mailing Address - Fax:
Practice Address - Street 1:4705 LAUREL CANYON BLVD STE 208
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-5929
Practice Address - Country:US
Practice Address - Phone:818-237-6422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist